Pediatr Infect Dis, 1986 Jul-Aug, 5(4), 421 - 3 Meningitis complicating acute bacteremic facial cellulitis; Baker RC et al.; Eighty cases of acute bacteremic facial cellulitis, 34 buccal and 46 preseptal, were reviewed from the years 1977 through 1982 . The epidemiology, clinical presentation, laboratory parameters and course of cellulitis in these two locations were similar . The white blood cell count was over 15,000 in three-fourths of the patients . Haemophilus influenzae type b was cultured from the blood of 67 patients, Streptococcus pneumoniae from 12 and Streptococcus pyogenes from 1 . Seven patients had culture-proved meningitis, six with H . influenzae type b and one with S . pneumoniae . Five of these patients had sparse clinical evidence of meningitis, and three of these had meningitis apparent by culture only . We conclude that meningitis may occur in association with acute bacteremic facial cellulitis and may be inapparent both clinically and by initial laboratory examination . We suggest aggressive initial evaluation and treatment of these infants pending culture results. Pediatr Infect Dis, 1986 Jul-Aug, 5(4), 416 - 20 Treatment of bacterial meningitis with ceftazidime; Hatch D et al.; Ceftazidime was prospectively evaluated in the treatment of bacterial meningitis in 19 pediatric patients . Haemophilus influenzae type b (HIB) was the etiologic agent in 17 patients, and Streptococcus pneumonia and Neisseria meningitidis were the etiologic agents in one patient each . Ceftazidime was administered intravenously in a dosage of 150 mg/kg/day divided into eight hourly doses for a mean of 15 days (range, 14 to 22 days) for H . influenzae type b meningitis . The clinical and microbiologic response was appropriate in all cases . The mean ceftazidime CSF concentration was 6.7 micrograms/ml at approximately 2 hours following iv infusions . This concentration was 16- to greater than 100-fold the minimal bactericidal concentration determined for the isolated pathogens . These preliminary observations support ceftazidime as a candidate cephalosporin for the treatment of bacterial meningitis caused by H . influenzae . Additional study is required to further define its role in meningitis caused by S . pneumoniae and N . meningitidis. Pediatr Infect Dis, 1986 Jul-Aug, 5(4), 408 - 15 Ceftazidime vs . standard therapy for pediatric meningitis: therapeutic, pharmacologic and epidemiologic observations; Rodriguez WJ et al.; One hundred patients ages 1 month to 15 years received either ceftazidime (CZ) at a dose of 150 mg/kg/day divided every 8 hours or conventional treatment with chloramphenicol and ampicillin (CA) . Seventy-eight had isolates recovered from the cerebrospinal fluid: 40 (51%) were Haemophilus influenzae (all ampicillin-susceptible); 16 (21%) were Streptococcus pneumoniae; 14 (18%) were Neisseria meningitidis; 3 (4%) were salmonellae; 1 (2%) was Pseudomonas; and 1 (2%) was Group B Streptococcus . Six patients with negative cerebrospinal fluid culture had positive latex agglutination (two H . influenzae, three N . meningitidis, one S . pneumoniae) . Sixty-one patients had positive blood cultures . CZ inhibited 100% of H . influenzae at 0.78 micrograms/ml, S . pneumoniae at 0.39, N . meningitidis at 0.04 and salmonellae at 0.39 micrograms/ml . The mean peak serum concentration of CZ was 36.4 micrograms/ml with a mean cerebrospinal fluid level of 7.4 micrograms/ml . If one eliminates from the statistics those patients who died less than or equal to 24 hours after admission, five (10%) of 49 patients treated with CZ died, one (2%) improved and 43 (88%) were cured . Overall 29 patients died, 12 receiving CZ (20%) and 8 receiving CA (21%) . There were no significant CZ-related toxicities . Gross neurologic sequelae were noted in 5% of 38 CZ patients and 4% of 28 CA patients . CZ compared favorably to CA for treatment of meningitis. J Pediatr, 1986 Jul, 109(1), 123 - 30 Cefuroxime versus ampicillin plus chloramphenicol in childhood bacterial meningitis: a multicenter randomized controlled trial; Marks WA et al.; In a multicenter randomized trial, 107 children with bacterial meningitis were initially given either cefuroxime or ampicillin plus chloramphenicol . Patients were alternately assigned to 7- or 10-day courses of the designated antimicrobial regimen . CSF isolates included Haemophilus influenzae type b (89, of which 25% were beta-lactamase positive), Streptococcus pneumoniae, and Neisseria meningitidis . Although mean CSF bactericidal titers against Haemophilus isolates were 1:6 in each treatment group, H . influenzae was cultured from CSF in four of 39 patients receiving cefuroxime, 24 to 48 hours after initiation of therapy, compared with none of 40 patients given ampicillin plus chloramphenicol (P = 0.11) . Clinical cure rates were similar (95%); one death occurred in each group . One child given cefuroxime had persistent meningitis after 5 days of therapy, and mastoiditis with secondary bacteremia developed in one on day 10 . Three patients had relapse or reinfection . One patient who received cefuroxime for 10 days had a relapse of epiglottitis 17 days later, and of the patients given ampicillin plus chloramphenicol, one had a relapse of meningitis 1 week after 7 days of therapy, and bacteremia developed in one 42 days after completion of 10 days of therapy . No increase in either in-hospital complications or relapses occurred with a 7-day treatment course . Proof of the equivalence of the antibiotic regimens and the efficacy of 7-day courses of treatment, as well as the consequences of delayed CSF sterilization, will require additional investigation. Infect Immun, 1986 Jul, 53(1), 71 - 8 Application of multilocus enzyme gel electrophoresis to Haemophilus influenzae; Porras O et al.; Multilocus enzyme electrophoresis was adapted to the study of Haemophilus influenzae . Protein extracts from sonicated whole bacteria were subjected to starch gel electrophoresis . After staining with substrates, the position of each isoenzyme (electromorph) was registered . Each isolate was assigned an electrophoretic type (ET) by the combination of electromorphs for the enzymes stained . Twenty-seven enzymes were tested; 12 were expressed in H . influenzae . Six enzymes were selected for subsequent study: malate dehydrogenase (MDH), phenylalanylleucine peptidase (PE2), 6-phosphogluconate dehydrogenase (6PG), adenylate kinase (AK), glucose 6-phosphate dehydrogenase (G6P), and phosphoglucose isomerase (PGI) . They were polymorphic and occurred in all isolates . Six electromorphs were found for PE2, G6P, and PGI, five for MDH, four for 6PG, and three for AK . PE2, G6P, and PGI contributed most of the ET resolution (48 of 49 ETs) . Multilocus enzyme electrophoresis showed several advantages over previous typing techniques . An ET could be assigned to both typable and nontypable (NT) isolates . The technique was powerful in resolving differences among isolates . The 94 isolates comprised 49 ETs, five biotypes, and six capsular types and NT isolates . Strains known to be related expressed the same ET, e.g., RAB b+ and b-, ET12; Ma a+ and a-, ET1 . ET variability among type b isolates was low; 26 of 28 clinical isolates expressed ET14; 2 of 28 expressed ET13 and ET15, differing from ET14 by one electromorph each . In contrast, the 47 NT isolates comprised 38 different ETs . No ETs were shared between non-type b capsulated strains and type b or NT strains . Interestingly, five NT isolates expressed the same ET as type b strains . (iv) Strains of the same capsular type but different biotypes expressed different ETs . ET determinations will thus be useful in studying the epidemiology and evolution of H . influenzae. Tohoku J Exp Med, 1986 Jul, 149(3), 271 - 82 Growth-enhancing effects of culture filtrates of sputum isolates on the L-forms of Haemophilus influenzae; Shishido H; The growth-enhancing effects of culture filtrates of respiratory pathogenic bacteria, including Haemophilus influenzae, as well as normal floral bacteria other than Neisseria perflava and Branhamella catarrhalis on L-forms of H . influenzae were examined in vitro, using five species of major respiratory pathogenic bacteria and seven species of normal floral bacteria commonly isolated from the sputum of patients with chronic respiratory tract infections . The growth-enhancing factor(s) was present in the filtrates prepared from the culture of respiratory pathogenic Streptococcus pneumoniae and Staphylococcus aureus, the effects of which were as potent as those of a culture filtrate of B . catarrhalis used as the positive control . The culture filtrates of respiratory pathogenic Pseudomonas aeruginosa and Klebsiella pneumoniae had weak growth-enhancing effects on H . influenzae L-forms . The culture filtrates of 21 strains of normal floral bacteria isolated from the sputum including alpha-hemolytic Streptococci, non-hemolytic Streptococci, Micrococcus roseus, coagulase-negative Staphylococci, and Neisseria spp . had growth-enhancing effects on the L-forms of H . influenzae . These data elucidate the significance of L-forms of H . influenzae in recurrent infections due to H . influenzae in patients with chronic respiratory tract infections. Tohoku J Exp Med, 1986 Jul, 149(3), 261 - 9 Growth-enhancing effect of Branhamella catarrhalis culture filtrates on the L-forms of Haemophilus influenzae; Shishido H et al.; Haemophilus influenzae is a common respiratory pathogen and recurrent infection due to H . influenzae is a phenomenon often present in patients with chronic respiratory tract infections . The effects of Neisseria perflava and B . catarrhalis culture filtrates on the growth and reversion of H . influenzae L-forms were determined using the L-forms of H . influenzae induced and subcultured in a medium containing 10% sucrose and these culture filtrates . When each culture filtrate of two strains of N . perflava was added, the viable count of revertants reached a peak of growth after 48 hr and exceeded 10(4) CFU/ml even 48 days after the subculture . Adding each culture filtrate of six strains of B . catarrhalis, the viable count of revertants from the L-forms of H . influenzae was much higher than that in the absence of any filtrate (negative control) . The filtrate of a culture prepared from one of the six strains of B . catarrhalis was subjected to biochemical analysis . The molecular weight of the growth-enhancing factor(s) was determined to be approximately 1,000 to 5,000 . Some peptide fractions showed growth-enhancing effects on the L-forms of H . influenzae . These findings suggest that culture filtrates may be important clues as to the correlation between recurrent infections due to H . influenzae and the growth of L-forms in the sputum of the patients with chronic respiratory tract infections, during or after the administration of beta-lactam antibiotics. Antimicrob Agents Chemother, 1986 Jul, 30(1), 39 - 41 Clinical evaluation of rosoxacin for the treatment of chancroid; Haase DA et al.; One hundred seven men with Haemophilus ducreyi-positive chancroid were assigned to receive 300 mg of rosoxacin as a single dose or 150 mg twice daily for 3 days . Ulcers and buboes were followed clinically and bacteriologically for 1 month . Of 40 evaluable males on the 3-day regimen, 38 (95%) were cured, while only 14 of 23 (61%) males on the single-dose regimen were cured; this regimen was discontinued . There was one ulcer relapse at day 21 in both groups; the one relapse in the single-dose group had a persistent culture-positive bubo . Eight of nine (89%) buboes followed to the endpoint on the 3-day rosoxacin regimen were cured, versus three of six (50%) on the single-dose regimen . Adverse effects were mainly related to the central nervous system but were minor and did not require intervention . None of the treatment failures was due to organisms resistant to rosoxacin, and failure of the single-dose regimen presumably was related to duration of tissue levels rather than to drug resistance . Administration of 150 mg of rosoxacin twice daily for 3 days is an effective regimen for the therapy of chancroid and is a reasonable alternative to other short-course regimens. Antimicrob Agents Chemother, 1986 Jul, 30(1), 179 - 80 Comparative in vitro activity of imipenem against Haemophilus influenzae and Haemophilus parainfluenzae; Cerami AT et al.; A microdilution broth method was used to test 77 clinical isolates of Haemophilus influenzae and Haemophilus parainfluenzae, including beta-lactamase-positive and -negative strains, for susceptibility to ampicillin, chloramphenicol, and imipenem . Except for ampicillin against beta-lactamase-producing strains (MIC for 90% of strains {MIC90}, greater than or equal to 128 micrograms/ml), all three antimicrobial agents had comparable in vitro activity (MIC90, less than or equal to 1 microgram/ml) against these bacterial strains. Arch Dis Child, 1986 Jul, 61(7), 691 - 2 Haemophilus influenzae type b meningitis resistant to ampicillin and chloramphenicol; Guiscafre H et al.; We report two cases of meningitis due to Haemophilus influenzae type b resistant to ampicillin and chloramphenicol . In one child the meningitis was preceded by pneumonia and pleural effusion . Both children responded to treatment with cefotaxime. Pediatrics, 1986 Jul, 78(1), 15 - 20 Haemophilus influenzae type b colonization in household contacts of infected and colonized children enrolled in day care; Li KI et al.; Strategies for management of children attending day-care facilities after a case of Haemophilus influenzae type b disease are controversial . The success of chemoprophylaxis in preventing subsequent cases has been variable . Failure of rifampin prophylaxis as currently recommended may result from usage limited to direct contacts of the index patient . This prospective study was designed to ascertain the extent of colonization in household contacts of colonized children attending day-care facilities with an index case of H influenzae disease . Outer membrane protein analysis was used to determine similarity between strains isolated from contacts and index patients . Of children attending six day-care facilities, 15% were colonized with subtypes of H influenzae identical with those of their respective index patients, and 7% of children were colonized with different subtypes . Colonization with identical outer membrane protein subtypes in children from day-care homes was more frequent than in the larger day-care centers (91% v 8%, P less than .00001) . Within families of children with identical outer membrane protein subtypes, 25% of household members (17% of parents and 44% of siblings) were colonized despite lack of direct contact with the index patients . This colonization rate was comparable to that of household contacts of index patients (26%) . Among household contacts of index patients, especially siblings, colonization with H influenzae tended to be lower if the patient attended day care than if the patient did not attend day care (17% v 73%; P = .05 for siblings) . We have found that household contacts of colonized day-care children are a reservoir of H influenzae.(ABSTRACT TRUNCATED AT 250 WORDS) Pediatrics, 1986 Jul, 78(1), 1 - 9 Use of bacterial antigen detection in the diagnosis of pediatric lower respiratory tract infections; Ramsey BW et al.; Two immunochemical methods were used to identify Haemophilus influenzae and Streptococcus pneumoniae capsular antigens in the urine and serum of 162 children with acute lower respiratory tract infection . These methods were compared with standard bacterial blood culture . Viral and mycoplasma cultures of respiratory secretions were obtained simultaneously to determine the frequency of antigenuria at the time of nonbacterial acute lower respiratory tract infection . Urine from groups of well children and children with acute otitis media was tested for capsular antigens to determine the incidence of antigenuria . Antigenuria was found in 24% of children 2 months to 18 years of age with acute lower respiratory tract infection compared with a 2% incidence of bacteremia . Antigenuria was found in 4% of asymptomatic children and 16% of children with acute otitis media . One third of children with symptoms of acute lower respiratory tract infection and viral isolates from the oropharynx had bacterial antigenuria . The sixfold increase in frequency of bacterial antigenuria in children at the time of lower respiratory symptoms suggests that bacterial acute lower respiratory tract infection may be more common than identified by traditional culture techniques . Because bacterial antigen may come from other sites such as the middle ear, further studies are needed to determine the role of antigen detection in the diagnosis of pediatric acute lower respiratory tract infection. J Bacteriol, 1986 Jul, 167(1), 44 - 8 Mutations affecting expression and maintenance of genes encoding the serotype b capsule of Haemophilus influenzae; Ely S et al.; Deletion mutagenesis analysis of a duplicated gene necessary for Haemophilus influenzae serotype b capsule expression showed that only one functional copy of this gene is required for capsule production and for virulence in infant rats . Mutant strains generated in this study differed from each other and from the parental strain in their ability to maintain the large tandem duplication which contains the genes involved in serotype b capsule expression. Infect Immun, 1986 Jul, 53(1), 79 - 89 Difference in structure between type b and nontypable Haemophilus influenzae populations; Porras O et al.; The extent of chromosomal genetic variability and the genetic structure of Haemophilus influenzae populations was analyzed . A total of 119 isolates from humans in Goteborg, Sweden, and Birmingham, Ala., and 16 strains from a type culture collection were characterized for capsular type, biotype, outer membrane protein profile, and enzyme electrophoretic type (ET) . The results of this study indicate that the bacteria identified as H . influenzae are a genetically extremely variable array of organisms . For the six enzymes studied, the estimated mean genetic diversity was 0.57 (approximately 20% higher than the corresponding estimate for Escherichia coli) . Two lines of evidence indicate that despite its ability to recombine by transformation, H . influenzae maintains a largely clonal population structure . Although there is considerable potential for generating different genotypes, there were only 88 distinct ETs among the 135 strains, and isolates of the same ET and biotype were recovered at frequencies greater than would be anticipated at random . This evidence for a clonal population structure holds for uncapsulated as well as capsulated strains . However, these data also suggest that the stability of H . influenzae clones (clone persistence time) may be less than that of the nontransforming species E . coli . The ET data indicate that there is somewhat less variability among H . influenzae strains that express the same capsular antigens, biotype, and outer membrane proteins than among randomly chosen isolates . Nevertheless, there is substantial genetic variation among isolates within each of these classes and combinations thereof . There is also variation in these typing characteristics among strains of the same ET . These observations and those on genetic variability and population structures have implications for the characterization of H . influenzae isolates in clinical and epidemiological studies. J Infect Dis, 1986 Jul, 154(1), 100 - 9 Epidemiology of colonization by nontypable Haemophilus influenzae in children: a longitudinal study; Spinola SM et al.; Eighty-six nasopharyngeal isolates of Haemophilus influenzae were prospectively obtained from three children who attended a day care center from infancy until early childhood (five to seven years) . A majority of the strains were nontypable . We analyzed strains by comparing their biotypes and by performing electrophoresis of outer membrane proteins on polyacrylamide gels . Profiles of outer membrane proteins were very heterogeneous and could not be used as the basis for the development of a subtyping scheme . The children characteristically carried a nasopharyngeal strain defined by a unique outer membrane pattern for a period of months, lost it, and then acquired a new strain . We probed the outer membrane proteins of a child's strains by the western blot technique with serum obtained serially from the child . Isolates whose outer membrane proteins appeared identical on stained gels generally had similar antigenic bands on western blots but were occasionally immunologically distinct . Serum immunoglobulins of the IgG class that reacted with the outer membrane proteins did not appear to change greatly over time or to play a role in preventing or terminating colonization . We conclude that nasopharyngeal colonization in children by nontypable H . influenzae is a dynamic process and that factors that cause loss and acquisition of strains remain to be determined. Jpn J Antibiot, 1986 Jul, 39(7), 1715 - 32 {Clinical evaluation of imipenem/cilastatin sodium in children}; Meguro H et al.; Imipenem/cilastatin sodium (MK-0787/MK-0791) was evaluated for its safety, efficacy and pharmacokinetics in children . Thirty cases of bacterial infections were treated with MK-0787/MK-0791 at a daily dose of 40 to 222 mg/kg for 2.25 to 13 days . Clinical cure rate was 93% and bacteriological efficacy rate was 88% . Treated diseases included severe tonsillitis due to mixed anaerobic infections, pneumonia, sepsis, brain abscess and soft tissue infections . Two cases, one with periosteomyelitis due to methicillin-resistant S . aureus and the other with pulmonary abscess due to Haemophilus influenzae (other than type b), failed to respond to the MK-0787/MK-0791 therapy . The serum half-life of MK-0787 was 0.892 hour in children with normal renal functions . An episode of convulsions in a case of sepsis with bacterial croup and brain edema was considered to be associated with the MK-0787/MK-0791 therapy . From the present study, MK-0787/MK-0791 appears a safe and effective antibiotic when used in children with a variety of bacterial infections. G Batteriol Virol Immunol, 1986 Jul-Dec, 79(7-12), 264 - 71 {Determination of the bactericidal potency of cefatrizine and other oral antibiotics against Haemophilus influenzae, Klebsiella pneumoniae and Streptococcus pyogenes}; Carlone NA et al.; The in vitro determination of the T log and the minimal bactericidal time of cefatrizine was evaluated against H . influenzae, Str . pyogenes A isolated from clinical specimens . and K . pneumonia ATCC 10031 and compared with that of amoxycillin, cefaclor, cefroxadine and miocamycin against the same bacterial strains . Cefatrizine demonstrate the shorter TMB against all bacterial strains and antibiotic tested with MBCs. J Pediatr, 1986 Jul, 109(1), 15 - 9 Risk factors for development of bacterial meningitis among children with occult bacteremia; Shapiro ED et al.; To identify risk factors for the development of bacterial meningitis, we compared clinical characteristics in children with occult bacteremia who did and those who did not subsequently develop bacterial meningitis . The estimates of risk were adjusted for the possible confounding effects of other characteristics by using logistic regression . Of 310 children (median age 15 months) who had occult bacteremia with Streptococcus pneumoniae, Haemophilus influenzae type b, or Neisseria meningitidis at either Yale-New Haven Hospital or Children's Hospital of Pittsburgh, bacterial meningitis subsequently developed in 22 (7%) . Compared with the risk associated with occult bacteremia with S . pneumoniae, the adjusted relative risk for bacterial meningitis was 85.6 (P less than 0.0001) and 12.0 (P = 0.0001) for N . meningitidis and H . influenzae type b, respectively . By contrast, the adjusted relative risk associated with a lumbar puncture at the initial visit was only 1.2 (P = 0.78) . The development of bacterial meningitis in children with occult bacteremia is strongly associated with the species of bacteria that causes the infection, but not with a lumbar puncture or with other clinical characteristics identifiable at the initial visit. Sex Transm Dis, 1986 Jul-Sep, 13(3), 145 - 50 Transfer of plasmid-mediated ampicillin resistance from Haemophilus to Neisseria gonorrhoeae requires an intervening organism; McNicol PJ et al.; Haemophilus species have been implicated as the source of plasmid-mediated ampicillin resistance in Neisseria gonorrhoeae . Previous attempts to transfer conjugally the resistance plasmids from Haemophilus species to N . gonorrhoeae have met with limited success . Using both biparental and triparental mating systems, it was found that transfer will occur if the commensal Neisseria species, Neisseria cinerea, is used as a transfer intermediate . This organism stably maintains resistance plasmids of Haemophilus and facilitates transfer of these plasmids to N . gonorrhoeae, in a triparental mating system, at a transfer frequency of 10(-8) . Both Haemophilus ducreyi and N . gonorrhoeae carry mobilizing plasmids capable of mediating conjugal transfer of the same resistance plasmids . However, restriction endonuclease mapping and DNA hybridization studies indicate that the mobilizing plasmids are distinctly different molecules . Limited homology is present within the transfer region of these plasmids. J Hosp Infect, 1986 Jul, 8(1), 96 - 103 Transfer of oropharyngeal bacteria into the trachea during endotracheal intubation; Nair P et al.; Thirty-seven patients undergoing surgical operations were studied to detect transfer of oropharyngeal organisms into the trachea during endotracheal intubation . Nine of 27 patients with potentially pathogenic bacteria in the pharynx immediately before intubation were found to have these organisms, mainly Haemophilus influenzae, in the trachea at the end of operation . There was a trend for systemic antibiotic prophylaxis to reduce the persistence of bacteria in the trachea. Pediatrics, 1986 Jul, 78(1), 21 - 5 Sequelae of acute bacterial meningitis in children treated for seven days; Jadavji T et al.; The sequelae of acute bacterial meningitis in children who were treated with ampicillin or chloramphenicol for seven days during the period January 1979 to June 1983 were assessed prospectively . The 235 patients (117 boys and 118 girls) ranged in age from four days to 18 years (mean 26.4 months) . Haemophilus influenzae type b was isolated in 70% of patients, Streptococcus pneumoniae in 20%, and Neisseria meningitidis in 10% . The mortality rate was 6.4% . No relapses occurred . Of the 220 survivors, 171 had neurologic psychometric, audiologic, and ophthalmologic assessments performed for a minimum of 1 year following their illness . One hundred thirty-six (80%) children had no detectable sequelae; 20% had mild to severe handicaps . The frequency of sequelae was greatest among children with S pneumoniae meningitis (57%) and least among children with N meningitidis (0%) . The sequelae observed included: sensorineural hearing loss (12.9%), developmental delay (5.3%), speech defect (4.7%), motor defect (3.0%), hydrocephalus (1.7%), and seizure disorder (1%) . The frequency of observed sequelae among these patients is similar to that previously reported in children treated for ten to 14 days . Our findings indicate that seven days of intravenous antibiotic therapy is adequate for the treatment of bacterial meningitis in children. JAMA, 1986 Jun 27, 255(24), 3369 - 73 Assessment of neonatal conjunctivitis with a direct immunofluorescent monoclonal antibody stain for Chlamydia; Rapoza PA et al.; Chlamydial conjunctivitis was diagnosed by direct immunofluorescent monoclonal antibody staining of conjunctival smears in 46 of 100 consecutive neonates with conjunctivitis . The remaining 54 infants had bacterial conjunctivitis most commonly caused by Staphylococcus, Streptococcus, and Haemophilus species . A comparison of the direct test with chlamydial cultures demonstrated a sensitivity of 100% and a specificity of 94%, whereas Giemsa stain had a sensitivity of 42% and a specificity of 98% . Nineteen percent of infants treated with oral erythromycin for chlamydial infections in accordance with Centers for Disease Control guidelines had clinical and laboratory evidence of persistent chlamydial conjunctivitis . We conclude that Chlamydia trachomatis is a major cause of neonatal conjunctivitis that can be effectively and rapidly diagnosed by direct immunofluorescent monoclonal antibody staining of conjunctival smears . Further evaluation of treatment regimens appears to be warranted. Aust Vet J, 1986 Jun, 63(6), 182 - 5 Investigation of purulent vaginal discharge in cows, with particular reference to Haemophilus somnus; Stephens LR et al.; The relationship between vaginal discharge, site of inflammation in the reproductive tract and species of bacteria isolated was examined in cows that were either normal, subfertile, or had had an abnormal parturition . Microbiological and cytological examinations were performed on uterine swabs from 221 cows and cervical swabs from 107 cows . There were 167 subferitle cows, 144 of which had failed to conceive to 3 or more services (FTC) and 23 of which had not had a visible oestrus since calving (NVO) . Metritis was diagnosed in 22% of the FTC cows, 48% of the NVO cows, and 12% of the cows with abnormal parturition . Fifty percent of cows with metritis had purulent vaginal discharge . However, only 25% of a total of 91 cows with vaginal discharge had metritis; the remainder had cervicitis . Fifty-four percent of subfertile cows had cervicitis without metritis . Mixed infection with aerobes and anaerobes was significantly correlated with uterine inflammation and was found in 20% of cows with metritis . The rate of isolation of H.somnus from inflamed uteruses (22%) and inflamed cervixes (39%) was significantly greater than the isolation rate from normal uteruses (8%) and cervixes (10%) . No bacteria were isolated from 50% of inflamed uteruses and 37% of inflamed cervixes . The number of subfertile cows with or without metritis that subsequently conceived was not significantly different. Vet Microbiol, 1986 Jun, 12(1), 77 - 85 Haemophilus somnus-induced interference with bovine neutrophil functions; Hubbard RD et al.; The effect of Haemophilus somnus on bovine polymorphonuclear leukocyte (PMN) function was examined in vitro with whole cells and fractions extracted from the surface of this bacterium . The ability of PMNs to iodinate protein and ingest Staphylococcus aureus was significantly inhibited in the presence of live cells, heat-killed whole cells or supernatant fluid from heat-killed cells, but not in the presence of washed, heat-killed cells . None of the fractions inhibited nitroblue tetrazolium (NBT) reduction by PMNs . The PMN inhibitory factors were further characterized . The material that inhibited S . aureus ingestion was found to be a heat-stable cell surface material of greater than 300 000 MW . The fraction inhibiting iodination of protein was found to be less than 10 000 MW. J Pediatr, 1986 Jun, 108(6), 887 - 96 Primary invasive Haemophilus influenzae type b disease: a population-based assessment of risk factors; Cochi SL et al.; We performed a population-based case-control study of risk factors for primary invasive Haemophilus influenzae type b (Hib) disease in metropolitan Atlanta from July 1, 1983, through June 30, 1984 . Active surveillance identified 102 cases in children less than 5 years of age, 89 of whom lived in households with telephones . We used random digit dialing to select 530 controls who were postmatched to cases by age . Multivariate analysis showed a significant association between Hib disease and two independent exposure factors, household crowding (odds ratio (OR) 2.7, 95% confidence limits (CL) 1.3 to 5.6) and day-care attendance . For day-care attendance, relative risk was highest in 2- to 5-month-old infants (OR 17.7, 95% CL 5.8 to 54.4) and declined to 9.4 (4.3 to 20.9) at ages 6 to 11 months, 5.0 (2.7 to 9.3) at 12 to 23 months, 2.7 (1.3 to 5.5) at 24 to 35 months, and 1.4 (0.5 to 4.0) in 36- to 59-month-old children . Fifty percent of all invasive Hib disease that occurred during the study period was attributable to exposure to day-care; the attributable risk for household crowding was 18% . Dose-response effects were observed for hours per week of day-care attendance and extent of household crowding . Breast-feeding was protective for infants less than 6 months of age (OR 0.08, 95% CL 0.01 to 0.59) . After controlling for socioeconomic and other confounding factors, we could demonstrate no effect of black race on cumulative risk of invasive Hib disease . Our study defines high-risk groups and provides a population-based model of the interrelationship between risk factors associated with invasive Hib disease. Infect Immun, 1986 Jun, 52(3), 792 - 7 Identification of suppressive components in "Haemophilus somnus" fractions which inhibit bovine polymorphonuclear leukocyte function; Chiang YW et al.; "Haemophilus somnus" fractions which inhibited iodination of protein by bovine polymorphonuclear leukocytes were isolated by heat extracting a washed bacterial suspension at 60 degrees C or incubating the bacterial suspension at 37 degrees C and were partially purified by ultrafiltration . The components in each fraction were separated by reverse-phase high-performance liquid chromatography and identified as ribonucleotides, a ribonucleoside, and purine and pyrimidine bases . Most of the compounds were found to be inhibitory to iodination in a dose-dependent manner . When the effect of each component on iodination at the concentrations present in "H . somnus" fractions was determined, it was found that guanine and GMP were the components responsible for most of the suppression in the fraction isolated by heat extraction, whereas guanine and adenine were the major inhibitory components in the fraction isolated by incubation at 37 degrees C. Pathol Biol (Paris), 1986 Jun, 34(5 Pt 2), 616 - 20 {Evaluation of the API ATB-CMI system for testing the sensitivity of Haemophilus influenzae to antibiotics . Comparison with other technics and reflections on interpretation criteria}; Dabernat H et al.; The API ATB-MIC system was used for antibiotic sensitivity testing of H . influenzae (following addition of NAD and hemin) . Results were compared to those obtained with agar dilution and disc diffusion . Eighty-four strains with a variety of resistance phenotypes (including beta-lactamase-producing strains and strains resistant to chloramphenicol, tetracycline or kanamycin) were tested . The API ATB-MIC system studies the susceptibility of H . influenzae to antibiotics by determining minimal inhibitory concentrations . Agreement between the methods ranged from 83% to 98% according to the antibiotic . Discrepancies involved ampicillin, minocycline and, to a lesser extent, chloramphenicol . These discrepancies had no influence on the interpretation of results except in one instance involving chloramphenicol . Comparison of the results obtained with each of the three methods leads to a discussion of the criteria that indicate resistance of H . influenzae and of the cutoff concentrations and diameters used for other species . Criteria indicating resistance are production of beta-lactamase for ampicillin, production of enzyme, a MIC above 2 mg/l or a diameter below 26 mm for chloramphenicol, and a diameter below 18 mm or a MIC above 4 mg/l for tetracycline and minocycline. J Pediatr, 1986 Jun, 108(6), 882 - 6 Persistence of antibody and response to booster dose of Haemophilus influenzae type b polysaccharide diphtheria toxoid conjugate vaccine in infants immunized at 9 to 15 months of age; Lepow M et al.; At approximately 2 years of age, 27 infants previously immunized at 9 to 15 months of age with two doses of polyribosylribitol phosphate-diphtheria toxoid conjugate vaccine (PRP-D) and 23 infants immunized with polyribosylribitol phosphate (PRP) vaccine were given a single injection of PRP-D . Pre- and post-immunization sera were obtained . No serious local or systemic reactions were observed . The PRP-D recipients had a geometric mean anti-PRP antibody level of 4.8 micrograms/ml 1 month after the second primary injection, retained 1.2 microgram/ml 1 year later, and had a level of 71 micrograms/ml after the booster immunization . In contrast, PRP recipients had a geometric mean level of 0.083 microgram/ml 1 month after the second primary injection, retained 0.042 microgram/ml 1 year later, and after a single dose of PRP-D at approximately 2 years of age had a geometric mean level of 8.6 micrograms/ml . The significantly higher antibody response in the prior PRP-D recipients suggests the recall of immunologic memory induced by the PRP-D vaccine. J Clin Microbiol, 1986 Jun, 23(6), 1015 - 21 Appearance of specific antibody-bearing cells in human bronchial mucosa after local immunization with bacterial vaccine; Latil F et al.; The immune response to local in vivo inhalation of a lysed bacteria vaccine was assessed in surgical specimens of main-stem bronchi from patients who had undergone pneumectomy for cancer . The patient population included 22 subjects; 11 of these received the aerosol vaccine twice a day for 10 days prior to surgery, while the remaining 11 patients were used as controls and were not immunized . The submucous glands of immunized subjects showed significantly more cells than did those of the controls, i.e., 62 +/- 8 versus 37 +/- 7, respectively (P less than 0.05) . The following five antigens were chosen for study by fluorescence assay: Streptococcus pneumoniae types II and III, Haemophilus influenzae, Streptococcus sp . strain D19, and Klebsiella pneumoniae . An immunization-dependent correlation was found between immunoglobulin A, immunoglobulin A-bearing cells, and specific antibody-bearing cells on the one hand and three of the five antigens (S . pneumoniae types II and III and Streptococcus sp . strain D19) on the other hand . This is the first time that a relationship has been established between bacterial immunization of the lower respiratory tract and local immunoglobulin production in humans. Infect Immun, 1986 Jun, 52(3), 812 - 7 Molecular cloning of DNA coding for outer membrane proteins of Haemophilus influenzae type b; Thomas WR et al.; DNA from Haemophilus influenzae type b was cloned in Escherichia coli with a vector lambda gt11 Amp1 . Clones producing antigens reactive with hyperimmune rabbit antisera were identified by colony radioimmune assay . A second screening with hyperimmune serum adsorbed with intact H . influenzae type b bacteria was used to identify those clones producing surface-exposed outer membrane proteins . The proteins expressed in E . coli were coupled to Sepharose and used to affinity purify antibodies which were tested for reactivity with outer membrane vesicles . It was found by Western blotting that the clones were producing antigens corresponding to Mr 49,000, 39,500, and 35,000 major outer membrane protein or antigens of H . influenzae type b . Additional clones could be detected by human serum, but their reactivity was not removed when serum was adsorbed with intact bacteria . One of these studied in more detail was found to produce an antigen present in H . influenzae type b lysate but not in outer membrane vesicle preparations. Zh Mikrobiol Epidemiol Immunobiol, 1986 Jun, (6), 59 - 62 {Sensitizing properties of soluble Haemophilus influenzae antigens}; Dobritsa VP et al.; The sensitizing properties of different doses of the antigenic preparation obtained from H . influenzae by ultrasonic treatment have been studied . Small doses of the antigen have been found to induce immunoallergic transformations of type IV in sensitized guinea pigs . A considerable increase in the sensitizing dose of the antigen has been found to lead to the appearance of allergic reactions of type I . The regularities of the development of allergy to H . influenzae are discussed. Acta Pathol Microbiol Immunol Scand {B}, 1986 Jun, 94(3), 177 - 84 Characterization of some previously unclassified "Pasteurella" spp . obtained from the oral cavity of dogs and cats and description of a new species tentatively classified with the family Pasteurellaceae Pohl 1981 and provisionally called taxon 16; Bisgaard M et al.; The taxonomic relationship of 23 unclassified canine and feline strains of Pasteurellaceae and five strains received as Pasteurella spp . or Haemophilus influenzae-murium was investigated by phenotypic and genetic characterization . Eleven strains were classified with four recently described species of genus Pasteurella sensu stricto . Fourteen canine and feline strains formed a homogeneous group, tentatively designated taxon 16 . Both phenotypic characters and mol% G + C in DNA and genome size indicate classification of taxon 16 with genus Pasteurella . DNA/DNA hybridizations, however, failed to locate taxon 16 on genus level with accepted or proposed species of the family Pasteurellaceae Pohl 1981 . Two additional species obtained from rats and mice remained unclassified, in addition to a human isolate obtained from a dog-bite . The necessity of detailed phenotypic characterization within the family Pasteurellaceae Pohl 1981 needs to be stressed. Acta Pathol Microbiol Immunol Scand {B}, 1986 Jun, 94(3), 167 - 71 Antibiotic susceptibility of Haemophilus influenzae isolated from cerebrospinal fluid and blood; Arpi M et al.; The emergence of ampicillin and chloramphenicol resistant Haemophilus influenzae type b in Denmark has created demands for alternative treatments of serious infections with H . influenzae . In this study 102 strains of H . influenzae recovered from cerebrospinal fluid (85) and blood (17) were tested for susceptibility to ampicillin, piperacillin, erythromycin, rifampicin, chloramphenicol, cefuroxime, cefotaxime, ceftazidime, ceftriaxone, moxalactam, aztreonam, and netilmicin by means of the agar dilution method . The majority (97%) was H . influenzae type b and of these strains 94% belonged to biotype I . Nine of the investigated strains were beta-lactamase producers . Ceftriaxone and cefotaxime were the most active agents (MIC90 less than or equal to 0.025 microliter/ml) followed by moxalactam and aztreonam (MIC90 = 0.1 microgram/ml) . Except for ampicillin and piperacillin, the MIC was similar for beta-lactamase producers and non-producers . Several of the investigated antibiotics, especially some of the third generation cephalosporins, might constitute valid therapeutical alternatives to conventional drugs in the treatment of severe H . influenzae infections. J Antimicrob Chemother, 1986 Jun, 17(6), 775 - 84 Influence of three modes of administration on the penetration of latamoxef into interstitial fluid and fibrin clots and its in-vivo activity against Haemophilus influenzae; Bergeron MG et al.; The extravascular penetration and bactericidal activity of latamoxef against beta-lactamase positive Haemophilus influenzae were studied in a rabbit model . All groups of animals received over 24 h an identical dose of 100 mg/kg of latamoxef given by three different intravenous modes of administration including a single large injection of 100 mg/kg, four 25 mg/kg intermittent injections every 6 h, and a continuous infusion of 100 mg/kg over 24 h . A single large injection resulted in significantly higher peak levels and higher initial area under the curve of concentrations of drug in serum, interstitial fluid, and fibrin clots than other modes of administration . Continuous infusion resulted in an accumulation of drug in clots which rose from 1.0 microgram/g at 4 h to 4.9 micrograms/g at 24 h (P value less than 0.01) . The rate of killing of H . influenzae imbedded in fibrin clots was greatly influenced by the different modes of therapy . Even though all regimens resulted in peak concentrations which were more than 80 times the MIC (0.03 mg/l) in the fibrin clots, rapid killing (from 10(7) to less than 10(2) micro-organisms per g of clots in less than 6 h) was only observed with a single bolus . Continuous infusion and intermittent injections of latamoxef resulted in limited in-vivo bactericidal activity . Large doses of latamoxef given at long intervals may be more effective than intermittent dosing or continuous infusion. Asian Pac J Allergy Immunol, 1986 Jun, 4(1), 5 - 11 Quantitation of isotype specific Haemophilus influenzae antibody in serum and saliva of normal subjects and chronic bronchitics; Cripps AW et al.; An immunoglobulin isotype specific radioimmunoassay procedure has been developed to assess the antibody response to Haemophilus influenzae somatic antigens in serum and mucosal secretions . This assay was reproducible (between assay CV% 13.9; within assay CV% 4.5 IgG, 3.9 IgA, 3.0 IgM) and specific for H1/H2 antigens . Different patterns of antibody were observed in healthy children (aged 5-10 years), adults and patients with chronic bronchitis . In serum, 20% of chronic bronchitics had antibody levels greater than those observed in healthy adults . In saliva, the proportion of chronic bronchitic patients with high levels (greater than 12% binding) of IgG specific antibody was significantly greater (P less than 0.05) than in healthy adults or children . The proportion of children and chronic bronchitics which had antibody levels of up to 4% binding was significantly greater (P less than 0.05) than that observed in healthy adults . A similar pattern was observed for IgM specific antibody . The occurrence of IgA specific antibody in the saliva in children and chronic bronchitics was consistently greater than that observed in adults for all levels of antibody (P less than 0.05) . Chronic bronchitics with high levels of antibody had greater infection and mortality rates. Antimicrob Agents Chemother, 1986 Jun, 29(6), 1090 - 1 Comparative activities of LY 164846 and other orally administered beta-lactam antibiotics against Haemophilus influenzae; Jorgensen JH et al.; LY 164846, a new oral cephalosporin, demonstrated very good inhibitory and bactericidal activities against Haemophilus influenzae irrespective of the production of beta-lactamase by the test strains . However, its activity was not markedly superior to that of either Augmentin (amoxicillin plus clavulanate) or cefaclor. J Med Microbiol, 1986 Jun, 21(4), 349 - 52 Isolation of Haemophilus influenzae and Haemophilus parainfluenzae from genital-tract specimens with a selective culture medium; Sturm AW; A series of 2027 genital tract specimens was cultured for Haemophilus species on non-selective chocolate agar and on a selective medium (Choc-VBCA) . The latter gave a significantly higher isolation rate . H . influenzae was isolated from 27 specimens and H . parainfluenzae from 81 specimens by use of the selective medium . The biotype distribution of both species was compared with that of an equal number of isolates from respiratory-tract secretions . H . influenzae biotypes II and IV were found to predominate in genital strains and biotypes II and III in respiratory strains . With H . parainfluenzae, biotype II was most frequent in both sites . Two new biotypes of H . parainfluenzae (VI and VII) are described . The significance of the use of selective media and of biotype distribution are discussed. J Pediatr, 1986 Jun, 108(6), 897 - 902 Multiply resistant Haemophilus influenzae type b causing meningitis: comparative clinical and laboratory study; Campos J et al.; Thirty-five patients with meningitis caused by Haemophilus influenzae type b were admitted to our hospital from January 1981 to December 1984; 60% of the strains were resistant to ampicillin, 65.7% to chloramphenicol, and 57% to both antibiotics . No significant differences in age, sex, previous treatment, clinical symptoms, outcome, and mortality were found between the 20 patients whose strains were resistant to both ampicillin and chloramphenicol and the other 15 patients whose strains were susceptible to ampicillin, chloramphenicol, or both . Alternative therapeutic agents were a combination of carbenicillin and gentamicin and new cephalosporins . At present, cefotaxime is our treatment of choice for meningitis caused by H . influenzae type b. J Clin Microbiol, 1986 Jun, 23(6), 1127 - 33 Penicillin resistance in the subgingival microbiota associated with adult periodontitis; Kinder SA et al.; In this investigation, the penicillin-resistant and beta-lactamase-producing subgingival microbiota associated with adult periodontitis was identified, and the impact of a recent exposure to penicillin on the recovery of resistant organisms from this microbiota was assessed . Subjects with adult periodontitis were examined clinically and microbiologically . Twenty-one subjects had a documented history of penicillin therapy within the previous 6 months whereas an additional 21 subjects had no history of antibiotic use within 1 year . Subgingival plaque samples were cultured anaerobically on nonselective and penicillin-containing elective media . MICs and beta-lactamase production were determined for the isolates from the elective medium . The penicillin-resistant microbiota consisted primarily of gram-negative organisms, including Bacteroides, Veillonella, Haemophilus, Eikenella, and Capnocytophaga species . The prevalence (P less than 0.05) and proportions (P less than 0.005) of both penicillin-resistant pigmented Bacteroides and Veillonella species were significantly greater in subjects with recent penicillin exposure . Of the penicillin-resistant genera identified, beta-lactamase production was detected in species of pigmented Bacteroides, Capnocytophaga, and Streptococcus . The prevalence of beta-lactamase-producing Bacteroides species was significantly greater in subjects with recent penicillin exposure (P less than 0.05) . Of the antibiotics examined, no single agent was uniformly effective against all of the penicillin-resistant strains, but metronidazole and clindamycin were active against all of the penicillin-resistant pigmented Bacteroides strains. Infect Immun, 1986 Jun, 52(3), 911 - 3 Comparison of in vivo and in vitro multiplication rates of Haemophilus influenzae type b; Rubin LG; A model of invasive Haemophilus influenzae type b disease in rats was used to compare the net in vivo and in vitro multiplication rates of this bacterium . In both the blood of rats and in vitro cultures (fresh rat blood or enriched broth) there was an exponential increase in the number of CFU per milliliter with calculated net mean generation times as follows: sham-operated rats, 82 +/- 39 min (n = 5); asplenic rats, 34 +/- 5 min (n = 13); broth, 26 +/- 4 min (n = 12); rat blood, 24 +/- 1 min (n = 14) . Thus, in vivo multiplication of H . influenzae type b can be extremely efficient. J Immunol, 1986 Jun 1, 136(11), 4232 - 6 Functional activity of different IgG subclass antibodies against type b capsular polysaccharide of Haemophilus influenzae; Weinberg GA et al.; The biologic activity of different human IgG subclass antibodies directed against the Haemophilus influenzae type b (Hib) capsular polysaccharide (PRP) was compared by using an in vitro complement-mediated bactericidal assay and an in vivo passive protection assay in infant rats . An IgG pool was made by Sephacryl S-300 chromatography of sera from adults immunized with PRP vaccine . An IgG2 subclass fraction was prepared by column immunoabsorption of the IgG pool with anti-IgG1 monoclonal antibody . An IgG1 subclass fraction was eluted from the affinity matrix . IgG1, IgG2, IgG3, and IgG4 concentrations in the fractions were measured by solid-phase competitive radioimmunoassays, and anti-PRP antibody was measured by a modified Farr assay . Each fraction was greater than 90% pure IgG2 or IgG1, respectively . There were no significant differences in the minimal anti-PRP antibody concentrations required to kill 50% of Hib cells in vitro (IgG, 0.22; IgG1, 0.21; and IgG2, 0.42 microgram/ml) . Similarly, equivalent amounts of anti-PRP antibody of the IgG1 or IgG2 fractions protected against bacteremia (IgG1, 0.12; IgG2, 0.24 microgram per rat) . IgG absorbed to remove anti-PRP antibody was neither bactericidal nor protective . Thus IgG1 and IgG2 anti-PRP antibody have equivalent functional activities against Hib as determined by these biologic assays. Acta Pathol Microbiol Immunol Scand {B}, 1986 Jun, 94(3), 173 - 6 Effects of carbon dioxide upon the in vitro activity of erythromycin; Dibb WL et al.; The in vitro activity of erythromycin against clinical isolates of Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus pyogenes and Haemophilus influenzae was examined by agar dilution and agar diffusion methods . The plates were incubated in air alone or in 8% CO2 and air . The minimal inhibitory concentrations (MICs) measured in air alone were lower for most of the isolates, compared to those found in 8% CO2 . The greatest differences in MIC values were found for H . influenzae; the MIC 50% was 0.5 mg/l in air and 4 mg/l in 8% CO2 . Sensitivity testing by the agar diffusion method (ICS) showed considerable differences between results obtained in air and in 8% CO2; the inhibition zones were generally smaller in CO2 . The most marked reduction in zone sizes after incubation in 8% CO2 was seen with the H . influenzae isolates; 15 out of 43 isolates moved from the "sensitive" to "moderately sensitive" group . Sensitivity determination of aerobic bacteria for erythromycin should be performed in air alone in the routine laboratory. J Clin Microbiol, 1986 Jun, 23(6), 1022 - 5 Some antigenic properties of Haemophilus parasuis and a proposal for serological classification; Morozumi T et al.; We propose a serological classification of Haemophilus parasuis into at least five serovars, using an agar-gel-precipitation test with extracts from autoclaved cells . Thirty-two strains were examined, and it was possible to classify 26 of them . The specific antigens were thermostable and soluble and were not affected by pronase treatment but could be extracted by phenol, suggesting a polysaccharide . This polysaccharide seemed to be identical with the capsular substance of serovars 1, 2, and 3 . In the presumably uncapsulated strains of serovars 4 and 5, the specific antigen was probably located in the outer membrane . The diversity of the specific substance within the different serotypes was shown by the differences in their electrophoretic migration patterns . Other extraction procedures showed that the washing supernatant and extracts at 60 and 100 degrees C were identical with the 121 degrees C extracts for serovars 1, 2, and 3 . In serovars 4 and 5, washing antigens, if present, were different from 100 and 121 degrees C extracts . Other common antigens, presumably proteinaceous antigens, were detected after extraction at 60 and 100 degrees C . The slide and tube agglutination tests allowed classification only for the capsulated strains of serovars 1, 2, and 3 . The specific agglutinogens were very sensitive to incubation temperature, and the absorption test showed them to be identical with the 121 degrees C precipitinogens. Antimicrob Agents Chemother, 1986 Jun, 29(6), 1110 - 2 Susceptibility of Haemophilus ducreyi to ampicillin and sulbactam in vitro; Jones BM et al.; The MICs of ampicillin, ampicillin plus sulbactam in equal proportions, and a range of ampicillin concentrations with a constant 0.5 micrograms/ml concentration of sulbactam were determined for 66 strains of Haemophilus ducreyi by an agar dilution technique with standardized inocula prepared by ultrasonication . Fifty-five strains were susceptible to ampicillin alone (MIC range, 0.06 to 1 microgram/ml) . The MICs for the 11 resistant strains were (micrograms per milliliter): range, 8 to greater than 16; MIC for 50% of the strains tested (MIC50), greater than 16; MIC90, greater than 16; 8 of them produced beta-lactamase . In the presence of an equal concentration of sulbactam, the MICs for ampicillin-resistant strains were lowered to (micrograms per milliliter): range, 0.125 to 2; MIC50, 0.25; MIC90, 1 . In the presence of a fixed 0.5-micrograms/ml concentration of sulbactam, the MICs for the resistant strains were (micrograms per milliliter): range, 0.125 to 2; MIC50, 0.125; MIC90, 0.25 . Sulbactam-ampicillin appears to be suitable for the treatment of H . ducreyi infections, especially those caused by ampicillin-resistant strains. J Biol Chem, 1986 May 5, 261(13), 6016 - 25 Characterization of Haemophilus influenzae nucleotide pyrophosphatase . An enzyme of critical importance for growth of the organism; Kahn DW et al.; A nucleotide pyrophosphatase isolated from Haemophilus influenzae was purified to electrophoretic homogeneity and characterized with respect to molecular weight, substrate specificity, pH profile, thermal stability, functional group involvement, and effectiveness of selective inhibition . The enzyme catalyzes the hydrolysis of NAD to NMN and AMP and appears located appropriately to facilitate the internalization of NAD needed to satisfy the V-factor growth requirement of the organism . In the processing of NAD and structurally related substrates, the enzyme exhibited negative cooperativity . Structural alterations in the purine moiety of these dinucleotide substrates had pronounced effects on the negative cooperativity of the enzyme . AMP, ADP, and several related nucleotides were observed to be effective substrate-competitive inhibitors of the enzyme . Several of the dinucleotides serving as substrates for the nucleotide pyrophosphatase were evaluated with respect to substituting for NAD in supporting growth of the organism . AMP and ADP inhibited growth of the organism when NAD served as V-factor, and this inhibition correlated well with the inhibitory effects of these nucleotides on the purified nucleotide pyrophosphatase. Am J Dis Child, 1986 May, 140(5), 424 - 7 Arthritis in children with bacterial meningitis; Likitnukul S et al.; Forty-eight patients with arthritis and meningitis were identified by hospital chart review among 2,089 cases of bacterial meningitis treated between 1969 and 1984 . The etiologic agents were Haemophilus influenzae in 38 cases (79%), Neisseria meningitidis in nine cases (19%), and Staphylococcus aureus in one case (2%) . Thirteen patients had more than one joint affected: two affected joints, ten patients; three affected joints, two patients; and four affected joints, one patient . The elbow (34%) and knee (29%) were most frequently affected . Joint-fluid aspirations were done in 44 patients; 22 cases (50%) had bacteria or bacterial antigen identified in joint fluid by culture, Gram's stain, or counter-immunoelectrophoresis: H influenzae (20 cases), N meningitidis (one case), and S aureus (one case) . Of the 48 patients, 14 patients were noted to have arthritis at the time of diagnosis of meningitis, 16 patients on the first to sixth day, and 17 patients on the seventh day of treatment or later; one patient developed arthritis 12 days after treatment of H influenzae meningitis had been stopped . Fourteen cases with a culture-proved bacterial etiology of the arthritis developed arthritis within four days of treatment; the exception was a patient who developed arthritis after treatment of meningitis was stopped . Of the 21 patients with culture-negative joint fluid and who developed arthritis later in the course of treatment, 19 patients were considered to have possible immune complex arthritis . Management consisted of antibiotic therapy in all patients, open incision and drainage in 17 patients (36%), and multiple aspirations in 12 patients (25%) . Of the remaining 19 patients, 15 patients had a single arthrocentesis performed and four patients had no aspiration . Early-onset arthritis appeared to be related to bacteremia whereas late-onset arthritis may be immune complex mediated. Pediatr Infect Dis, 1986 May-Jun, 5(3), 298 - 303 Once daily ceftriaxone for central nervous system infections and other serious pediatric infections; Yogev R et al.; Ceftriaxone has a very long serum half-life and enhanced in vitro activity against common pediatric pathogens . Therefore we evaluated the efficacy and safety of once daily ceftriaxone therapy in 57 children with serious infections including: meningitis (26 patients); ventriculitis (3); pyelonephritis (7); osteomyelitis (6); abscess (4); septic arthritis (3); sepsis (2); and miscellaneous infections (6) . The most common isolates were Haemophilus influenzae (23), Escherichia coli (9) and Staphylococcus aureus (8) . Ceftriaxone was given intravenously or intramuscularly in a dose of 50 mg/kg for non-central nervous system (CNS) infections . Patients with CNS infections received an initial dose of 100 mg/kg followed by 80 mg/kg 12 hours later and once daily thereafter . In a limited number of patients no major differences in serum ceftriaxone concentrations were found after intravenous or intramuscular injection . Of 57 patients with pathogens isolated 55 were completely cured; in one patient with Klebsiella pneumoniae ventriculitis, intraventricular gentamicin was briefly added to the regimen . Another patient with an anaerobic liver abscess recovered after metronidazole was administered . In three patients a delayed response to ceftriaxone was noted . One patient with previous recurrent infections had a second episode of H . influenzae meningitis 22 days after cessation of therapy . Clinical side effects were noted in 10 of 71 patients (including 14 treated patients who had negative cultures) . Seven patients had diarrhea, one each had fever or rash and one had fever, rash and arthralgia . Laboratory side effects in 16 of 71 patients included eosinophilia (7), thrombocytosis (7), elevated liver enzymes (4) and leukopenia and neutropenia (2).(ABSTRACT TRUNCATED AT 250 WORDS) J Pediatr, 1986 May, 108(5 Pt 1), 647 - 53 Spectrum of IgG2 subclass deficiency in children with recurrent infections: prospective study; Shackelford PG et al.; Serum immunoglobulins and IgG subclasses were measured in 30 children with recurrent infections . Seven patients had low IgG2 concentrations (less than 3SD below the geometric mean for age) . Four of these seven patients had normal concentrations of IgG, IgA and IgM, and thus would have been considered immunologically normal by routine criteria . The seven children with IgG2 deficiency had more severe infections than the 23 children with normal IgG2 . Five children had recurrent pneumonia or sinusitis, one had recurrent invasive Haemophilus influenzae type b infections, and one had severe pneumococcal meningitis . Their immunologic abnormalities were heterogeneous . Two children had isolated IgG2 deficiency, two had IgG2-IgG4 deficiency, one had IgG2-IgG4-IgA deficiency, one had IgG2-IgA deficiency, and one had severe IgG1-IgG2 deficiency with abnormal T cell function and thrombocytopenia . Thus IgG2 deficiency occurs frequently among children with recurrent infections, and is associated with a variety of clinical and immunologic abnormalities. Infect Immun, 1986 May, 52(2), 414 - 20 Outer membrane protein profiles of Haemophilus pleuropneumoniae; Rapp VJ et al.; Outer membrane protein profiles of Haemophilus pleuropneumoniae were examined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis . Cells were disrupted by sonication, and outer membrane-enriched fractions were prepared by differential centrifugation and selective solubilization of the inner membrane with sodium N-lauroyl sarcosinate . Colony type, growth medium, time of harvest, and in vitro or in vivo passage had no appreciable effect on the protein profiles of the strains examined . Seven patterns were distinguished among the reference strains of the nine capsular serotypes . These patterns were based on the mobility of the major outer membrane proteins migrating in the 39,000- to 44,000-molecular-weight region of the gel, a 16K to 16.5K protein, and a heat-modifiable 29K protein . Strains of serotypes 1 and 9 had identical outer membrane protein profiles, as did strains of serotypes 2 and 6 . The reference strains of the remaining five serotypes each had a distinct pattern . The outer membrane protein profiles of 95 field isolates belonging to serotypes 1, 5, 7, and 9 from swine in the midwestern United States were determined and compared with the reference patterns . The results indicate that the population of H . pleuropneumoniae is clonal, with three predominant clones distinguished by both serotype and outer membrane protein profile responsible for the majority of H . pleuropneumoniae disease occurring in swine in the United States. Pathol Biol (Paris), 1986 May, 34(5), 479 - 82 {Treatment of neurosurgical bacterial meningitis using the combination of ceftriaxone-fosfomycin}; Stahl JP et al.; 16 patients with bacterial meningitis following a neurosurgical procedure were given a combination of ceftriaxone and fosfomycin . 8 microorganism were isolated: 2 Staphylococcus epidermidis, 1 Staphylococcus aureus, 1 Neisseria meningitidis, 1 Streptococcus pneumoniae, 1 Haemophilus influenzae, 1 Serratia marcescens and 1 Aeromonas hydrophila . No pathogen was identified in the remaining cases . All of the isolated strains were susceptible to both antibiotics . In vitro, neither synergy nor antagonism were observed between the two antimicrobial agents . The acute infectious episode resolved in all patients . One relapse only was observed, in a patient with meningitis related to a ventricular shunt, and successfully treated by the same therapeutic schedule associated with removal of the tubing . Lastly, CSF concentrations of both antibiotics were assayed and found to be comparable with those reported by most author. Pathol Biol (Paris), 1986 May, 34(5), 381 - 4 {Growth curves and killing rate of Haemophilus influenzae exposed to amoxicillin, cefaclor and cefotaxime}; Yourassowsky E et al.; The antibacterial activity of beta-lactams against H . influenzae is difficult to evaluate as a result of the osmotic-pressure-dependent formation of filaments and spheroplasts whose viability is still under debate . We compared growth curves obtained by optic density measurements and by UFC/ml counts for H . influenzae in the presence of amoxicillin, cefaclor and cefotaxime in various concentrations . Only the early response to antibiotics, observed during the first six hours of antibiotic-culture contact, was considered . Results showed, for each of the three antibiotics: an increase in optic density with formation of abnormal organisms that correlated poorly with antibiotic concentrations; a stable number of UFC/ml for more than 90 mn, followed by a slow fall reaching at the most 1.5 Log 10 UFC/ml at the sixth hour . We conclude that amoxicillin, cefaclor and cefotaxime in active concentrations rapidly produce the formation of abnormal organisms with an increase in biomass as a result . These abnormal organisms lose their viability slowly, even with concentrations greater than 50 time the MIC . Cefaclor's MIC and MBC are underestimated when results are read only after 24 hours. Pathol Biol (Paris), 1986 May, 34(5), 372 - 8 {Prevalence of antibiotic resistance of Haemophilus influenzae isolated in France: a year of activities of the network of surveillance for H . influenzae infections}; Dabernat H et al.; The prevalence of antimicrobial resistance among clinical isolates of Haemophilus influenzae was assessed in France . A total of 705 isolates, obtained from CSF (98 strains), blood (76), ears (118), eyes (164), lower respiratory tract specimens (144), genital specimens (28), and various other specimens (71) were examined . These isolates were obtained from microbiological laboratories distributed throughout France and were sent to the Center for the study of H . influenzae during one year . Biotype of isolates was determined by use of API 10 E system and serotype was determined by slide agglutination procedure . All isolates were examined for beta-lactamase production with a chromogenic test . Susceptibility to ampicillin, cefotaxime, gentamicin, kanamycin, chloramphenicol, tetracycline, minocycline, erythromycin and rifampicin was determined by disk diffusion test and MIC determination by agar dilution procedure . Drug resistance was observed for 92 strains (13%) . The overall resistance was 11.2% to ampicillin (all but one strain were beta-lactamase producers), 9% to tetracycline (Tc), 3.4 to chloramphenicol (Cm) and 6.8% to kanamycin (Km) . Eleven phenotypes of resistance were observed: the most frequently observed were Ap-Km-Tc, Ap, Ap-Km-Cm-Tc, Ap-Tc, Ap-Km, Tc . Antimicrobial resistance rates varied by specimens: resistance to ampicillin concerned 12.2% of the strains from CSF, 10.5% from blood, 12.5% from sputum, 16.1% from ears, 6.7% from eyes; tetracycline resistance concerned 14.2%, 10.5%, 10.4%, 7.6% and 4.8% of the same strains respectively; resistance to chloramphenicol concerned 4%, 5.2%, 1.3%, 3.3% and 2.4% of the strains respectively.(ABSTRACT TRUNCATED AT 250 WORDS) Jpn J Antibiot, 1986 May, 39(5), 1279 - 96 {A comparative, well-controlled study of ceftizoxime suppository against ceftizoxime intravenous injection in infantile acute pneumonia}; Fujii R et al.; We have attempted to clinically define the therapeutic usefulness of ceftizoxime suppository (CZX-S) in children with bacterial pneumonia, in a randomized trial . Intravenous injection of ceftizoxime (CZX) was used as the control . The results are summarized below . Subjects were inpatients with bacterial pneumonia, ranging in age from 9 months to 7 years and 10 months . As a rule, the daily dose was either four 250 mg (in potency) suppositories given at 6-hour intervals or 60 mg/kg body weight intravenous CZX (control) given in 4 injections at 6-hour intervals over a period of 7 days . The number of children in the study was 67 . These children were divided into 2 dosage groups (suppository, 35; injection, 32) with matching pretreatment background factors . The severity of the target disease in the majority of the children was "moderate" . The rate of therapeutic effectiveness was 97.1% for the suppository and 93.8% for the injection, and did not differ significantly between the 2 groups . Rates of efficacy by severity, presence or absence of underlying diseases, daily dose and/or complications were high without exception, and did not differ significantly between the 2 groups . Eradication rates for causative microorganisms, as studied in 16 children of each group, were both 93.8% . The 2 most frequently isolated causative organisms were Haemophilus influenzae and Streptococcus pneumoniae . Side effects were examined for 36 children of each group . The frequency of side effects did not differ significantly between the suppository group (2 with diarrhea and 1 with abdominal pain) and the injection group (1 with urticaria), and 8.3% and 2.8%, respectively . The frequency of abnormal laboratory test findings differed significantly (P less than 0.01) with respect to eosinophilia which occurred in 7 (20.6%) of the injected subjects but was not encountered in the subjects treated with suppositories . Other abnormal laboratory findings included thrombocytosis in 3 (14.3%) of the injection group and increased GOT in 1 (3.2%) of the suppository group . The suppository formulation of CZX appears to be a highly useful substitute for the injectable form, and should find a special use in children whose treatment with injections experiences some difficulty. J Infect Dis, 1986 May, 153(5), 879 - 87 Use of dot-immunobinding and immunofluorescence assays to investigate clinically suspected cases of chancroid; Schalla WO et al.; In 1984 and 1985, outbreaks of genital ulcers occurred in Florida and New York . Initial investigations for syphilis, herpes simplex, Chlamydia trachomatis, and Haemophilus ducreyi did not implicate any of these organisms as etiologic agents . From the results of dot-immunobinding assays, we found that sera from the patients had higher levels of IgM (30 {47.6%} of 63 patients) and IgG (22 {34.9%} of 63 patients) reactivities with an outer-membrane preparation from H . ducreyi strain CIP542 than with outer-membrane preparations from Haemophilus influenzae ATCC 10211 or Haemophilus parainfluenzae ATCC 7901 . In contrast, sera from 35 patients in the control group did not react with any of the outer-membrane preparations (P less than .01 for both IgM and and IgG reactivity), nor did sera from eight individuals with disease caused by H . influenzae (P = .051 for IgM reactivity, P = .02 for IgG reactivity) . Indirect immunofluorescence assay using a monoclonal antibody reactive with outer-membrane preparations from H . ducreyi strain CIP542 stained organisms in smears of lesion material from genital ulcers from three of six patients . These results suggested that the cause of both outbreaks of genital ulcers was H . ducreyi which was subsequently isolated in both geographic areas. Infect Immun, 1986 May, 52(2), 519 - 28 Quantitative and qualitative analyses of serum antibodies elicited in adults by Haemophilus influenzae type b and pneumococcus type 6A capsular polysaccharide-tetanus toxoid conjugates; Schneerson R et al.; Covalent binding to immunogenic proteins increases the immunogenicity of the capsular polysaccharides of Haemophilus influenzae type b (Hib) and pneumococcus type 6A (Pn6A) . Conjugates composed of Hib, Pn6A, or the cross-reacting Escherichia coli K100 covalently bound to tetanus toxoid (TT) were injected into young adult volunteers . Local reactions were common and were probably due to Arthus reactivity mediated by the preexisting antibodies reacting with the TT component of the conjugates . Fever occurred in about 10% of the volunteers after the first injection; no volunteers had fever after the second injection . Similar levels of Hib or Pn6A antibodies were elicited by either 50- or 100-micrograms doses or by concurrent injection of two different conjugates (Hib-TT and Pn6A-TT or Hib-TT and K100-TT) . The Hib-TT elicited about a 180-fold increase in Hib antibodies, and the Pn6A-TT conjugate elicited about an 8-fold increase in Pn6A antibodies after one injection . Booster reactions were not elicited in adults; similar levels of antibodies in the five experimental groups suggested that the responses elicited by the conjugates were maximal . A one-way cross-reaction was noted as Pn6A conjugates elicited rises of Hib antibodies in 13 of 20 volunteers; only 4 of 59 volunteers immunized with Hib-TT had increases in Pn6A antibodies . The preimmunization Hib antibodies were composed of immunoglobulin M (IgM), IgA, and IgG . The postimmunization sera showed an increase in all three isotypes; the elevation of the IgG was the highest of the three isotypes . Conjugate-induced antibodies to both the polysaccharide and TT exerted biological activities that have been correlated with immunity . Adsorption of the Hib-TT onto aluminium hydroxide resulted in higher levels and an earlier Hib antibody response in infant rhesus . These results encourage the evaluation of Hib and Pn6A conjugates in human children and infants. Arch Otolaryngol Head Neck Surg, 1986 May, 112(5), 554 - 7 Antibody response in experimental Haemophilus influenzae otitis media; Yamaguchi T et al.; Because Haemophilus influenzae is one of the most common pathogens in otitis media with effusion, we have investigated the antibody response in the serum and middle ear effusion (MEE) in nontypable H influenzae-induced experimental acute otitis media in the chinchilla, using an enzyme-linked immunosorbent assay . During acute otitis media, a reasonable antibody titer was observed: local antibody titers in the MEEs were equal to or greater than those of the serum samples for four of five MEE samples obtained at one week after inoculation . By two weeks, titers in both serum and MEE samples were increased significantly . However, the bacteria persisted in the middle ear cavity, even in the presence of increasing antibody titers, for up to five weeks after infection . The reason for this persistence of the bacteria in the middle ear is unknown. Mol Gen Genet, 1986 May, 203(2), 296 - 9 Effect of glycerol on plasmid transfer in genetically competent Haemophilus influenzae; Stuy JH et al.; The small plasmid pAT4 transformed at characteristically low frequencies those competent Haemophilus influenzae Rd strains that had no DNA homology with this plasmid . Transformation was increased up to 100 times, however, when the recipient cells were exposed to 30% glycerol before plating for transformants . Expression of plasmid resistance markers was then immediate . Ultraviolet irradiation experiments indicated that this large increase was due to release by the glycerol of double-stranded plasmid molecules, presumably from transformasomes . Several other plasmids exhibited the same phenomenon . Dimethylsulfoxide also stimulated plasmid transformation but lysolecithin and high concentrations of NaCl or glucose were ineffective . Glycerol did not increase the efficiency of transformation by either chromosomal DNA or linearized plasmid DNA. Antimicrob Agents Chemother, 1986 May, 29(5), 921 - 2 In vitro activity of the new macrolide antibiotic roxithromycin (RU 28965) against clinical isolates of Haemophilus influenzae; Jorgensen JH et al.; The in vitro activity of the new macrolide antibiotic roxithromycin (RU 28965) was compared with the activities of five other orally absorbable antimicrobial agents against 100 clinical isolates of Haemophilus influenzae . Roxithromycin MICs were generally twofold to fourfold higher than those of erythromycin; the MIC for 90% of the strains for roxithromycin was 8 micrograms/ml. J Infect, 1986 May, 12(3), 247 - 9 Meningitis due to beta-lactamase producing, chloramphenicol-resistant Haemophilus influenzae type b, in South Africa; Coovadia YM et al.; A case of meningitis and septicaemia due to Haemophilus influenzae type b resistant to both ampicillin and chloramphenicol is reported . After initial failure of chloramphenicol therapy, the patient responded to cefotaxime alone . To our knowledge, this represents the first such reported case in South Africa. Pediatrics, 1986 May, 77(5), 633 - 5 Red man syndrome: inadvertent administration of an excessive dose of rifampin to children in a day-care center; Bolan G et al.; A cluster of toxic reactions among children inadvertently given excessive doses of rifampin for chemoprophylaxis of invasive Haemophilus influenzae disease in a day-care center was investigated . In all 19 children, who received five times the therapeutic dose of rifampin, dramatic adverse reactions developed . A striking, "glowing" red discoloration of the skin and facial or periorbital edema were found to be the hallmarks of rifampin toxicity . These clinical signs of acute toxicity contrast sharply with the adverse side effects of rifampin reported with therapeutic doses. J Med Microbiol, 1986 May, 21(3), 219 - 24 Characterisation of Haemophilus spp . isolated from infant conjunctivitis; Roberts MC et al.; Haemophilus strains isolated from children under the age of 11 months with conjunctivitis were characterised by biotype, sugar fermentation, plasmid pattern and outer-membrane-protein profiles . H . influenzae was the most common species identified and was separated into 14 groups based on sugar fermentation and biotype patterns and into more than 20 groups when plasmid and outer-membrane-protein profiles were included . Small (mol . wt less than 10 X 10(6)) plasmids were identified in 11 of 34 (32%) H . influenzae isolates, 1 of 2 H . haemolyticus and 4 of 6 (67%) H . parainfluenzae isolates . Examination of sugar-fermentation and plasmid patterns increased the ability to distinguish between strains isolated at different times from recurrent disease and may have general applications in the study of Haemophilus strains isolated from a single anatomical site. Infect Immun, 1986 May, 52(2), 572 - 8 Protection by serum antibodies in experimental nontypable Haemophilus influenzae otitis media; Barenkamp SJ; The chinchilla experimental model of otitis media was used to examine the importance of serum antibodies in protection against disease caused by nontypable Haemophilus influenzae . An immune serum pool was prepared by immunizing chinchillas with killed bacterial cells of nontypable H . influenzae 3245 . Pooled preimmune or immune serum from these immunized animals was administered intravenously to a group of nonimmune chinchillas 1 day before intrabullar challenge with strain 3245 . Of 5 animals receiving preimmune serum, 5 developed otitis media compared with 0 of 10 animals receiving immune serum (P = 0.008) . The immune serum pool contained antibodies directed against both surface-exposed outer membrane proteins and lipopolysaccharide (LPS) . The 39-kilodalton major outer membrane protein was the immunodominant surface protein . Anti-LPS antibodies were removed from the immune serum pool by affinity chromatography, and affinity-purified anti-LPS antibodies were recovered . Immune serum, immune serum absorbed of LPS antibodies, or affinity-purified LPS antibodies were then administered to another group of experimental animals 1 day before bacterial challenge . Of four animals that received the affinity-purified LPS antibodies, four developed otitis compared with zero of four animals that received the immune serum or zero of four animals that received the LPS-absorbed immune serum (P = 0.028) . These studies indicate that passive immunization with immune serum is protective in experimental nontypable H . influenzae otitis media and that bacterial outer membrane proteins may be the principal targets of protective antibody. Infect Immun, 1986 May, 52(2), 397 - 400 Chemiluminescent response of polymorphonuclear leukocytes to Streptococcus pneumoniae and Haemophilus influenzae in suspension and adhered to glass; Hayashi K et al.; We measured the luminol- and lucigenin-enhanced chemiluminescent response of human polymorphonuclear leukocytes (PMN) stimulated by various strains of Streptococcus pneumoniae and Haemophilus influenzae . In the absence of opsonin, phagocytosis of either bacterial species elicited good PMN response when the bacteria were adhered to a surface but minimal PMN response when they were in suspension . When 10% pooled human serum was used as a source of opsonin, a moderate to excellent chemiluminescent PMN response was elicited during phagocytosis of opsonized bacteria both in suspension and adhered to surface . We conclude that opsonin significantly enhances PMN chemiluminescence when a suspension-type assay is used and that opsonin-independent mechanisms play a significant role in the chemiluminescent response of PMN during phagocytosis of adherent bacteria. Infection, 1986 May-Jun, 14(3), 129 - 33 Impact on peritonsillar infections and microflora of phenoxymethylpenicillin alone versus phenoxymethylpenicillin in combination with metronidazole; Tuner K et al.; In a double-blind study, 20 patients with peritonsillar abscesses were treated with 2 g phenoxymethylpenicillin b.i.d . for ten days together with needle aspiration, incision and daily drainage, and 20 patients were treated with 2 g phenoxymethylpenicillin b.i.d . and 0.8 g metronidazole b.i.d . for ten days together with needle aspiration, incision and daily drainage . Group A beta-hemolytic streptococci were isolated from pus in 20 of the patients with peritonsillar abscesses, in five of these together with indigenous oropharyngeal aerobic and anaerobic microorganisms . Pure anaerobic bacteria were found in nine abscesses, together with indigenous aerobic microorganisms in eight, and together with group A, C and G streptococci in five . In one patient heavily colonized with beta-lactamase-producing Staphylococcus aureus, Haemophilus parainfluenzae and Bacteroides, group A beta-streptococci failed to be eradicated . In the penicillin group, nine of 18 patients harboured beta-lactamase producing Bacteroides strains in the tonsils on the day of admission . On the third and tenth days of treatment all patients harboured beta-lactamase producing Bacteroides strains in the tonsils, while in the penicillin + metronidazole group, only one out of 17 patients still harboured beta-lactamase producing Bacteroides strains . None of the patients harboured beta-lactamase producing fusobacteria on the day of admission . In the penicillin group, however, beta-lactamase producing fusobacteria were recovered from three patients on the tenth day of treatment . No beta-lactamase producing fusobacteria were recovered from the penicillin + metronidazole group.(ABSTRACT TRUNCATED AT 250 WORDS) Pediatr Infect Dis, 1986 May-Jun, 5(3), 333 - 6 Time course of radiometric detection of positive blood cultures in childhood; Meadow WL et al.; We have determined the time course of radiometric detection of microbial growth in 2348 positive blood culture specimens obtained at Wyler Children's Hospital during a 5-year interval . Overall 72 and 88% of isolates were detected within 48 and 72 hours after sampling, respectively . For pathogenic organisms aerobic detection was generally more rapid and more inclusive than anaerobic detection . At 48 hours of incubation the detection of six potential pathogens (Salmonella sp., Haemophilus influenzae, Group D streptococci, Neisseria meningitidis, coagulase-negative staphylococci, Candida sp.) was significantly delayed compared with detection of other pathogenic organisms recovered from blood . At 72 hours of incubation the detection rates remained less than 95% for H . influenzae, Staphylococcus aureus, Klebsiella sp., coagulase-negative staphylococci, Group D streptococci and Candida sp . These data should assist clinical decisions regarding duration of antibiotic therapy for the presumptive diagnosis of bacteremia in children. Pediatr Infect Dis, 1986 May-Jun, 5(3), 293 - 7 Safety and efficacy of once daily ceftriaxone for the treatment of bacterial meningitis; Congeni BL et al.; Fifty-seven patients with bacterial meningitis were treated with once daily ceftriaxone . After an initial loading dose of 100 mg/kg, the patients received 80 mg/kg as a single daily dose . Etiologic agents included: Haemophilus influenzae type b, 37 (11 beta-lactamase-positive); Neisseria meningitidis, 11; Streptococcus pneumoniae, 6; Streptococcus pyogenes, 1; Haemophilus influenzae type f, 1; and Group B Streptococcus, 1 . All patients showed clinical improvement and all were bacteriologically cured . Satisfactory cerebrospinal fluid bactericidal activity and drug concentrations were seen 24 hours after a dose even in those patients in whom repeat spinal taps were carried out following the last dose of therapy . The drug was well-tolerated and the major adverse effect seen was diarrhea in 20.4% of the patients . The diarrhea was mild and self-limited and did not necessitate discontinuation of the drug although it was frequently associated with alterations in the stool microbiologic flora . Based on this preliminary experience, ceftriaxone, when given in a single daily dose, appears safe and effective in the treatment of bacterial meningitis in nonneonatal infants and children. Mol Gen Genet, 1986 May, 203(2), 288 - 95 Homology-facilitated plasmid transfer in Haemophilus influenzae; Stuy JH et al.; The 8 kbp plasmid pAT4 transformed Haemophilus influenzae Rd cells at low frequencies . Transformation was increased up to 100 times, however, when the recipient cells carried a DNA segment in either their chromosome or in a resident plasmid that was homologous to at least part of plasmid pAT4 . Linearized plasmid DNA molecules did not transform cells without DNA homology; they efficiently transformed homology recipients, but only when the cuts had been made in the region of shared homology . In most cases examined the circular donor plasmid had been reconstituted from the transforming DNA; in some cases the reconstituted plasmid carried a mutation initially present in the recipient chromosome, provided the transforming plasmid had been linearized in the region of shared homology . Plasmid reconstitution was not observed in recA1 cells . We conclude that homology-facilitated plasmid transformation (transfer) is similar to that reported for Bacillus subtilis and Streptococcus pneumoniae. Br Med J (Clin Res Ed), 1986 Apr 26, 292(6528), 1103 - 5 Increase in bronchopulmonary infection due to branhamella catarrhalis; McLeod DT et al.; In a six month prospective study during the winter Branhamella catarrhalis was isolated from the sputum of 63 patients with symptoms of bronchopulmonary infection: 49 isolates were in pure culture and 14 were with another pathogen, Haemophilus influenzae being the commonest (found with 10 of the 14 B catarrhalis isolates) . Of 36 patients infected in the community, 26 required admission to hospital . The remaining 27 patients were infected while in hospital . Forty four of the 63 isolates produced beta lactamase; 26 of these had been acquired in the community . As a result 29 patients were treated inappropriately with ampicillin and did not respond to this treatment . beta Lactamase produced by B catarrhalis may also protect other pathogens normally susceptible to beta lactam antibiotics . Most patients had chronic lung diseases or lung cancer, but three otherwise healthy patients who did not smoke developed bronchitis . B catarrhalis contributed to the death of five patients . A survey of the antibiotic prescribing habits of the referring general practitioners together with the sensitivity results of B catarrhalis suggest that changes in antibiotic prescribing habits in the community may be responsible for the increase in B catarrhalis infection. Schweiz Med Wochenschr, 1986 Apr 5, 116(14), 431 - 40 {Prospective evaluation of coagglutination and latex agglutination in the diagnosis of bacterial meningitis in childhood}; Kobelt R et al.; Two simple and low-priced kits to detect bacterial antigens in cerebrospinal fluid (CSF) specimens from patients with suspected meningitis have recently become available . Methods employed by these kits are staphylococcal coagglutination (COA) and latex agglutination (LA) . The COA "Phadebact CSF-kit" (Pharmacia) detects Haemophilus influenzae type b (HIb), Neisseria meningitidis (NM) groups A, B, C, Y and W 135 and Streptococcus pneumoniae (SP), whereas the LA "Slidex Meningite-kit" (BioMerieux) includes HIb, NM A, NM C and SP . These two diagnostic tests were compared with the standard methods for analyzing CSF specimens from children with suspected meningitis . A total of 336 CSF specimens were tested . Forty-three were from children with bacterial meningitis due to HIb, NM or SP obtained before antimicrobial therapy . Thirty-four of them (79%) were correctly detected by COA, 23 (54%) by LA, and 42 (97%) by microscopic analysis of stained smears . There were 65 CSF samples of such meningitis cases obtained after initiation of antimicrobial therapy: COA detected 26 (40%), LA 17 (26%) and staining 26 (40%) . With culture-positive CSF specimens from patients before therapy, the best sensitivities were obtained with LA for SP (100%) and COA for HIb (87%), whereas the results for NM antigen detection were only 43% with COA and 0% with LA (no reagent against NM B) . Cross-reactions with other bacterial antigens were frequent with COA (26%) and rare with LA (2%), resulting in false-positive findings in 6 of the 66 positive tests with COA (9%) but in none of the 40 positive tests with LA (0%) . One of the 48 specimens from aseptic meningitis cases was false-positive for HIb by COA, whereas all 172 normal specimens were negative with both methods . With 5 culture-negative CSF specimens from patients with unequivocal purulent meningitis COA detected bacterial antigen in 5 and LA in 2 . Conclusions: The two kits evaluated cannot replace standard methods for analyzing CSF specimens, in view of insufficient sensitivity (mainly LA) or frequent cross-reactions and false-positive values (COA) . However, due to their simplicity, rapidity, and possible identification of bacterial pathogens after initiation of antimicrobial therapy, these kits are recommended as an useful addition to standard methods. JAMA, 1986 Apr 4, 255(13), 1757 - 62 The treatment of chancroid; Schmid GP; Since the treatment of chancroid was reviewed in 1982, the results of subsequent treatment trials have offered the clinician additional therapeutic choices as well as shorter courses of therapy . Erythromycin (500 mg four times a day for seven days) provides consistently effective treatment for cases acquired throughout the world, although erythromycin-resistant strains have been isolated in Singapore . Sulfamethoxazole and trimethoprim (800 mg/160 mg orally twice a day for seven days), ceftriaxone (250 mg intramuscularly one time), and amoxicillin/clavulanic acid (500 mg/125 mg orally three times a day for seven days) are also efficacious . There is, however, significant geographic variability in the susceptibility of Haemophilus ducreyi to sulfamethoxazole and trimethoprim, suggesting this combination may become increasingly less effective, and a lack of in-depth experience in the treatment of chancroid with ceftriaxone and amoxicillin/clavulanic acid. J Trop Med Hyg, 1986 Apr, 89(2), 67 - 70 Multiresistant Salmonella ohio infections at the University Hospital of the West Indies; Macfarlane DE; During 1982-83 there was a substantial increase in the number of S . ohio infections at the University Hospital of the West Indies, which coincided with the appearance of strains resistant to chloramphenicol, cotrimoxazole, ampicillin, neomycin and carbenicillin . Multiresistant strains of S . ohio accounted for 19.3% of all salmonella isolates during this period and all of 40 strains tested were able to transfer resistance determinants to E . coli K12 J 53-2 . S . ohio was cultured from stool (60), blood (5), wounds and abscesses (4) and postmortem material (2) . Eighty-six per cent of S . ohio infections occurred in children of 3 years old or less . There was a high incidence of gastroenteritis in malnourished children, a 14% incidence of localizing infections and a 7% incidence of septicaemia . Two infants with severe gastroenteritis and bronchopneumonia died . There were a number of unusual infections including two cases of septicaemia in children receiving chloramphenicol for Haemophilus influenzae meningitis, a scrotal abscess secondary to extravasation of urine and infected scabies in a child with marasmic kwashiorkor. Antimicrob Agents Chemother, 1986 Apr, 29(4), 576 - 8 Reduction of oral flora with rifampin in healthy volunteers; Appelbaum PC et al.; The effect of a short course of rifampin on the oral microflora was evaluated in 17 healthy volunteers . Salivary specimens were collected before and after two 600-mg doses of rifampin administered 6 h apart . Salivary bacteria were identified to species, and total quantitative colony counts were determined for each isolate . For all 17 subjects, treatment with rifampin led to a reduction in total bacterial colony counts; the mean inhibitory activity was 85.8% (range, 48.3 to 99.8%) . Both aerobic and anaerobic bacteria were inhibited in every case: 45.5 to 99.8% for aerobic bacteria, mean inhibitory activity of 85.8%; 40.9 to 100% inhibition for anaerobic bacteria, mean inhibitory activity of 87.6% . However, total counts were reduced by greater than or equal to 2 logarithms in only 18% of individuals; for aerobes, in 29%; and for anaerobes, in 41% . All classes of bacteria were inhibited, with mean inhibitory activities ranging from 8.4 to 99.9% . However, only streptococci, Haemophilus spp., Bacteroides spp., and aerobic and anaerobic gram-positive nonsporeforming rods were reduced in counts close to 2 logarithms after treatment with rifampin . Clinical studies are needed to clarify the significance of these in vitro data and to delineate a possible role for rifampin in preoperative prophylaxis of patients undergoing head and neck cancer surgery. South Med J, 1986 Apr, 79(4), 480 - 2 Haemophilus paraphrophilus endocarditis; Bryan JP et al.; We have described a previously healthy medical student who had endocarditis due to Haemophilus paraphrophilus necessitating replacement of the mitral valve . We compared this case to the 11 previously reported cases of endocarditis caused by this organism, stressing the fastidious nature of the organism, its destructive nature, and its propensity for thromboembolism. J Clin Microbiol, 1986 Apr, 23(4), 777 - 82 Selective medium for the isolation of Haemophilus aphrophilus from the human periodontium and other oral sites and the low proportion of the organism in the oral flora; Tempro PJ et al.; We developed a medium for the selective recovery of Haemophilus aphrophilus . The medium, designated TSBVF, was composed of 4% tryptic soy agar, 10% heat-inactivated horse serum, 75 micrograms of bacitracin per ml, 5 micrograms of vancomycin per ml, and 50 micrograms of sodium fluoride per ml . TSBVF yielded a threefold higher recovery of oral H . aphrophilus than did chocolate agar with 75 micrograms of bacitracin per ml, which is a medium routinely used to diagnose human Haemophilus infections . H . aphrophilus and the few contaminating organisms on TSBVF were readily distinguished on the basis of colony morphology . The H . aphrophilus isolates exhibited variable fermentation of raffinose and dextrin but otherwise were biochemically similar . In a clinical study, H . aphrophilus was frequently recovered from supragingival plaque and saliva and occasionally from buccal mucosa and the tonsils . It was also isolated from 29 of 56 subgingival sites in 11 of 14 subjects . Its proportion of the subgingival microflora averaged 0.13% for healthy periodontal sites, 0.05% for adult periodontitis lesions, and 0.03% for localized juvenile periodontitis lesions . We concluded that H . aphrophilus is an indigenous bacterium of the human oral cavity . It occurs in low proportions in subgingival plaque and plays no apparent role in advanced periodontal disease in humans. Can J Vet Res, 1986 Apr, 50(2), 238 - 44 An evaluation of the API ZYM system as a means of identifying Haemophilus somnus and related taxa; Groom SC et al.; The commercially available API ZYM microbiological identification system was evaluated for the rapid identification of Haemophilus somnus . Eighty-seven isolates of the organism had API ZYM profiles which were characteristic . The API ZYM profiles demonstrate clear differences between H . somnus and other genera but suggest a close association to three related organisms . Enzyme activity of H . somnus isolates were similar to organisms identified as Histophilus ovis, Haemophilus agni and strains UQV of Actinobacillus actinoides and Actinobacillus seminis but was clearly different from isolates of Pasteurella haemolytica, Pasteurella multocida, Bordetella bronchiseptica and group EF4 . The API ZYM system allowed more rapid identification of H . somnus than conventional biochemical tests and may be a useful adjunct to conventional methods used for identification of H . somnus isolates . The test did not reveal obvious differences between isolates from various anatomic locations. J Clin Invest, 1986 Apr, 77(4), 1084 - 95 Morphologic alterations of the blood-brain barrier with experimental meningitis in the rat . Temporal sequence and role of encapsulation; Quagliarello VJ et al.; The cerebral capillary endothelium is unique and functions as an effective blood-brain barrier (BBB) owing to its intercellular tight junctions and rare pinocytotic vesicles . To assess how bacterial meningitis alters the BBB, rats were inoculated intracisternally with three encapsulated meningeal pathogens (Escherichia coli K1+, Streptococcus pneumoniae type III, Haemophilus influenzae type b) and an unencapsulated mutant strain (H . influenzae Rd) . After defined infection durations, the morphologic alterations of the cerebral capillary endothelium were quantitatively assessed by transmission electron microscopy . Results revealed a significant increase in pinocytotic vesicle formation (P less than 0.001) early after meningitis induction (4 h) that was sustained with longer infection durations (10 h, 18 h) for all encapsulated strains tested . In addition, there was a progressive increase in completely separated intercellular junctions with increasing infection duration, (P less than 0.05) . 4 h after induction of meningitis with H . influenzae Rd, cerebrospinal fluid (CSF) bacterial concentrations, cerebral capillary morphologic changes, and functional BBB permeability to circulating 125I-albumin were similar to those observed with H . influenzae type b . However, prolonging the H . influenzae Rd infection to 18 h allowed for CSF clearance of the organism, thereby precluding the significant increase in separated junctions or progression of functional BBB permeability seen with the encapsulated H . influenzae type b . These data suggest a uniform morphologic explanation for altered BBB permeability in meningitis with a reproducible temporal sequence . Encapsulation does not appear essential for BBB injury, but may facilitate its progression by allowing the organism to evade host clearance. Infect Immun, 1986 Apr, 52(1), 171 - 4 Retained antigen-binding activity of Fab alpha fragments of human monoclonal immunoglobulin A1 (IgA1) cleaved by IgA1 protease; Mansa B et al.; Immunoglobulin A1 (IgA1) proteases may be important virulence factors of certain bacteria involved in the pathogenesis of meningitis, gonorrhea, destructive periodontal diseases, and some other infections affecting mucosal membranes . This study evaluated the antigen-binding activity of free Fab alpha fragments released from human myeloma IgA1 by IgA1 protease from Haemophilus influenzae . Six myeloma proteins with antibody activity against streptolysin O, alpha-staphylolysin, or streptococcal hyaluronidase were used . Complete cleavage of the IgA1 myeloma proteins in the hinge region of the heavy chain did not affect their antigen-binding capacity . The titers of neutralizing activity associated with free Fab alpha fragments were not significantly different from those of the intact IgA1 proteins . The retained antigen-binding capacity of cleaved IgA1 is an important factor in the understanding of how IgA1 proteases may interfere with the immune protection of mucosal membranes. Mikrobiyol Bul, 1986 Apr, 20(2), 76 - 83 {Incidence of Haemophilus influenzae in throat cultures}; Berkman E; Present study is carried out in order to determine the incidence of Haemophilus influenzae in the throat cultures examined Microbiology Laboratory of Hacettepe Children's Hospital . Throat culture specimens were first inoculated into blood agar and also tryptic soy agar plates . BVX, BV and BX discs were placed on inoculated tryptic soy agar surface for selective growth . The colonies grown around discs were also subjected to agglutination test with specific monovalent and polyvalent antisera for definite diagnosis . As a result, 37 H . influenzae (% 2.96) isolated out of 1249 throat culture tested and 12 (0.96) of isolates classified as type b. Antimicrob Agents Chemother, 1986 Apr, 29(4), 594 - 7 In vitro comparison of ampicillin-chloramphenicol and ampicillin-cefotaxime against 284 Haemophilus isolates; Lapointe JR et al.; Since November 1982 at the Sainte-Justine Hospital in Montreal, ampicillin and cefotaxime were used in association as initial treatment (greater than or equal to 48 h) for childhood bacterial meningitis . In this report is described the in vitro interaction of the new regimen in comparison with that of the previous ampicillin-chloramphenicol combination against 284 Haemophilus isolates . Among the 156 ampicillin-susceptible, beta-lactamase-negative isolates, synergy was detected in 13 with ampicillin-cefotaxime, and antagonism was detected in only 1; in contrast, synergy was found in only 2 strains with ampicillin-chloramphenicol, and antagonism was found in 15 . These differences were statistically significant (P less than 0.01) . Such significant differences were not observed among the 128 ampicillin-resistant, beta-lactamase-positive Haemophilus isolates . The synergy of ampicillin-cefotaxime did not contribute to a decrease of the MIC of cefotaxime for 90% of isolates tested, whereas the antagonism of ampicillin-chloramphenicol did not contribute to increase the MIC of ampicillin for 90% of isolates tested. Antimicrob Agents Chemother, 1986 Apr, 29(4), 565 - 9 Combined action of chloramphenicol and ampicillin on chloramphenicol-resistant Haemophilus influenzae; Mackenzie AM et al.; The interaction of ampicillin and chloramphenicol on three ampicillin-susceptible, chloramphenicol-resistant strains of Haemophilus influenzae was studied by checkerboard testing with subcultures, time-kill experiments, and a disk method . In all three strains there was inhibition of the bactericidal action of ampicillin by chloramphenicol at concentrations close to the MIC (10 micrograms/ml) . This chloramphenicol concentration was close to that which might be achieved in cerebrospinal fluid during treatment for meningitis and was in the bactericidal range for chloramphenicol-susceptible organisms . It is suggested however that in the initial treatment of meningitis caused by ampicillin-susceptible, chloramphenicol-resistant strains, inhibition of the action of ampicillin by chloramphenicol may represent a clinical risk. Antimicrob Agents Chemother, 1986 Apr, 29(4), 560 - 4 In vitro activity of an orally administered cephalosporin, LY164846, against potentially pathogenic respiratory and dermal bacterial isolates; Lauderdale BL et al.; The antibacterial activity of LY164846, a new orally administered semisynthetic cephalosporin, was compared with that of amoxicillin-clavulanic acid against 492 potentially pathogenic respiratory tract and dermal isolates . Against groups A, B, and G streptococci; pneumococci; staphylococci (other than methicillin resistant); Haemophilus influenzae; Branhamella catarrhalis; and meningococci, the MICs for 90% of strains tested of LY164846 and amoxicillin-clavulanic acid were less than or equal to 4 and less than or equal to 1 microgram/ml, respectively . LY164846 was equally active against beta-lactamase-positive and -negative strains of Haemophilus and Staphylococcus . MBC to MIC ratios of LY164846 versus H . influenzae were less than or equal to 2, while those with Staphylococcus aureus were more difficult to determine because of skipped tubes or paradoxic effects . There were minimal inoculum, pH, or serum effects on LY164846 activity against H . influenzae and S . aureus . In time-kill studies, LY164846 and amoxicillin-clavulanic acid at double MICs were 99.9 to 100% bactericidal to H . influenzae in 24 h; two times the MIC of LY164846 and four times the MIC of cephalexin were 99.9 to 100% bactericidal to S . aureus in 24 h . Based on error-rate-bounded analysis, the following interpretative guidelines for 30-micrograms LY164846 disk diffusion test diameters are suggested: greater than or equal to 19 mm, susceptible (MIC, less than or equal to 4 micrograms/ml); 16 to 18 mm, intermediate (MIC, greater than 4 but less than or equal to 8 micrograms/ml); less than or equal to 15 mm, resistant (MIC, greater than 8 micrograms/ml). South Med J, 1986 Apr, 79(4), 417 - 9 Prospective study of pneumonia: unexpected incidence of legionellosis; Rudin JE et al.; In a prospective study of the etiology of pneumonia in patients hospitalized at a university hospital, all respiratory secretions were tested for routine pathogens as well as Legionella . A diagnosis was established in 60 of 87 patients studied . Of the 37 nosocomial infections, six were caused by L micdadei . Gram-negative rods, Staphylococcus aureus, and Streptococcus pneumoniae and Haemophilus influenzae were also important organisms in this group . In the community-acquired cases, gram-negative rods caused 26% of infections . These data emphasize both the importance of Legionella in hospitals and the changing spectrum of both hospital- and community-acquired pneumonia. J Bacteriol, 1986 Apr, 166(1), 285 - 9 Effect of glycerol on Haemophilus influenzae transfection; Stuy JH; Competent Haemophilus influenzae bacteria were exposed to purified phage HP1 DNA and then plated for transfectants (PFU) . When 32% (final concentration) glycerol was added before plating, between 10- and 100-fold more transfectants were observed . Glycerol had no significant effect on transfection with DNA from single or tandem double lysogens . It also had little effect on transformation with chromosomal DNA or on transformation of defective HP1 lysogens with phage HP1 DNA . It was concluded that glycerol induced the release of adsorbed linear double-stranded DNA into the interior of the cells. Infect Immun, 1986 Apr, 52(1), 183 - 91 Genetic relationships of serologically nontypable and serotype b strains of Haemophilus influenzae; Musser JM et al.; A collection of 242 strains of Haemophilus influenzae, including 65 nontypable (unencapsulated) isolates and 177 encapsulated serotype b isolates recovered largely from children with invasive and noninvasive diseases in the United States, was characterized by the electrophoretic mobilities of 15 metabolic enzymes presumably encoded by chromosomal genes . All enzymes were polymorphic for three to seven electromorphs, and 94 distinctive multilocus genotypes (electrophoretic types {ETs}) were distinguished, among which mean genetic (allelic) diversity was 0.500 . Isolates recovered from cases of invasive or noninvasive diseases did not differ significantly in level of genetic variation . The observation that 29 ETs were represented exclusively by serotype b isolates and that each of the 65 nontypable isolates was of a unique ET strongly confirmed the hypothesis that unencapsulated clinical isolates are not merely phenotypic variants of the common serotype b cell lines . Rather, the two types of isolates are distinctive subsets of the multilocus chromosomal genotypes of the species as a whole . Serotype b capsule occurred in three groups of isolates that are distantly related in multilocus enzyme genotype . Isolates of four closely related nontypable biotype IV ETs associated with obstetrical infections or neonatal bacteremia were highly divergent from all others examined and may be specifically distinct . A phylogenetic scenario was proposed in which the ancestor of H . influenzae was encapsulated and the nontypable clones arose by convergent evolutionary loss of the ability to synthesize or extracellularly express a polysaccharide capsule. Am J Dis Child, 1986 Apr, 140(4), 381 - 5 Use of rifampin in Haemophilus influenzae type b infections; Li KI et al.; Based on evidence that patients with infections due to Haemophilus